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Birth Weight, Gestational Age and Insurance Are Predictors of Breastfeeding

Monday, October 22, 2012
Room 346-347 (Morial Convention Center)
Cristina Fernandez, MD1, Corrine K. Hanson2, Elizabeth Lyden2 and Ann L. Anderson Berry, MD2, (1)Pediatrics, Creighton University, Omaha, NE, (2)Pediatrics, University of Nebraska Medical Center, Omaha, NE

Purpose: Successful establishment of breastfeeding in low birth weight or premature infants can be difficult. Our purpose was to evaluate the impact of birth weight, gestational age, and insurance status on breastfeeding status, at both the initial pediatrician visit and the 6 month follow up visit.

Methods: Medical records of 1246 infants at both their first pediatrician and 6 month pediatrician visits were reviewed. Data was collected on gestational age at birth, birth weight, insurance type, and feeding method, exclusive breast feeding, formula feeding or combination feeding.  Descriptive statistics were displayed for all variables. One-way ANOVA was used to compare continuous data between the first visit BF groups and if significant, Tukeys test was used for pairwise comparisons.  The independent t- test was used to compare continuous data between the 6 month BF groups. Associations of categorical variables were assessed with the Chi-square test or Fisher's exact test when appropriate.  Logistic regression was used to model predictors of BF (breast or both vs. bottle) at first visit and BF at the 6 month visit. A p-value < 0.05 was considered statistically significant.

Results:   Gestational age was significantly associated with a woman's BF behavior at the first visit after adjusting for insurance status (p=0.0004).  After adjusting for insurance status, the odds ratio of BF at the first visit associated with a 1-week increase in gestational age is 1.12 (95% CI 1.05 to 1.20). Birth weight was also significantly associated with a woman's BF behavior at 6 months after adjusting for insurance status and gender of the infant (p=0.0031).  Specifically, when comparing 2 groups of mothers of the same insurance status and with infants of the same gender, the group of mothers whose infants were 500 grams larger (about 1 pound) in birth weight will have an odds of BF at 6 months that is 1.02 times the odds of BF for the group of mothers with infants of the lower birth weight. Type of insurance, private vs. public, also was significantly associated with BF behavior at the first visit after adjusting for gestational age (p<0.0001). After adjusting for gestational age, private insurance is associated with increased odds (OR= 3.72) (95% CI 2.78 to 4.97) of BF when compared to the group of women with public or no insurance.

Conclusion:   Identifying specific populations at risk for decreased initiation of or early discontinuation of breastfeeding will allow practitioners to provide targeted interventions to assist these groups with successful BF.  Our results indicate, lower birth weight, lower gestational age, and public insurance are all associated with decreased breastfeeding are target populations for intervention.